Provider Demographics
NPI:1578897047
Name:SUMRALL, BILLI J (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:BILLI
Middle Name:J
Last Name:SUMRALL
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13053 WOODBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2483
Mailing Address - Country:US
Mailing Address - Phone:228-539-5278
Mailing Address - Fax:
Practice Address - Street 1:13053 WOODBRIDGE CT
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2483
Practice Address - Country:US
Practice Address - Phone:228-539-5278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist